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General NPI Number Information
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NPI Number | 1356094247
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Entity Type | Individual
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Provider Name | SIERRA BODILY DDS
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Gender | Female
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 151 E 5600 S
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City | MURRAY
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State | UT
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Zip | 84107-6181
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Country | US
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Telephone | 208-852-1560
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Fax | 208-852-1560
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Provider Business Mailing Address
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Address Line | 16 S 200 E
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City | KAYSVILLE
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State | UT
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Zip | 84037-2018
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Country | US
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Telephone | 208-852-1560
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 12782441-9924
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 5171473
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License Number State | ID
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